Addiction

The American Society of Addiction Medicine (ASAM) is a professional society representing over 3,000 physicians and mental health professionals who are dedicated to increasing the understanding and treatment of addictions.

In 2011 ASAM released the following definition of addiction:

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”.

ASAM added the following comments regarding the neurology of addiction:

“Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors.

Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors”.

Most addictions have one thing in common. They reflect an attempt to manage or cope with emotional or physical pain by inducing experiences that promote a feeling of well-being and/or at least provide an “escape”. The only real difference between one addiction and another is the “hook” or the experience which helps the addict manage his or her emotional states.

For example, with sex addiction the hook can be the experience of escaping into a euphoric high stimulated by specific sexual activity.  With alcoholism the hook can be either the personality change that comes with getting drunk or the anesthetizing effect of alcohol on one’s pain. With workaholism the hook is often the distraction that comes with focused concentration on an activity. With overeating, it can be the unconscious association between food and nurturing. With love addiction, the hook may be romantic fantasies which may help deaden feelings of loneliness and rejection and promise ‘happiness ever after’.

A person who is addicted to either a substance and/or an activity is unable to control their addictive behaviour. Such individuals have often tried many times to reduce or stop their behaviour but have been unsuccessful. In the past, the term ‘addiction’ has mainly been applied to alcohol and drug use. However, it is possible to become addicted to almost any activity that produces a mood-altering and ‘medicating’ affect. Such activities may include sex, television, gambling, Internet games, spending money, eating, shopping, work or exercise.

Research has shown that there can be a number of factors underpinning a person’s propensity to addictive behaviour including genetic influences, childhood abuse or neglect, traumatic life experiences, dysfunctional relationships, stress, and an inability to manage emotions. Most people with an addiction will require a specialised recovery program to help them break their addictive behaviour patterns and establish new healthier patterns.